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DAGLI STILI DI VITA AI FARMACI ( O DAI FARMACI AGLI STILI DI VITA?)

DAGLI STILI DI VITA AI FARMACI ( O DAI FARMACI AGLI STILI DI VITA?). Dr. Brunello Cappelli. Prevalence of Overweight*. * Body mass index ≥ 25 kg/m². S2 vs. S1 : P=0.15 S3 vs. S2 : P=0.22 S3 vs. S1 : P=0.02. P=0.04. Prevalence of Obesity*. * Body mass index ≥ 30 kg/m².

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DAGLI STILI DI VITA AI FARMACI ( O DAI FARMACI AGLI STILI DI VITA?)

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  1. DAGLI STILI DI VITA AI FARMACI (O DAI FARMACI AGLI STILI DI VITA?) Dr. Brunello Cappelli

  2. Prevalence of Overweight* * Body mass index ≥ 25 kg/m² S2 vs. S1 : P=0.15 S3 vs. S2 : P=0.22 S3 vs. S1 : P=0.02 P=0.04

  3. Prevalence of Obesity* * Body mass index ≥ 30 kg/m² S2 vs. S1 : P=0.009 S3 vs. S2 : P=0.051 S3 vs. S1 : P=0.0002 P=0.0006

  4. Prevalence of Central Obesity* * Waist circumference ≥ 102 cm in men or ≥ 88 cm in women S2 vs. S1 : P=0.0001 S3 vs. S2 : P=0.47 S3 vs. S1 : P<0.0001 P<0.0001

  5. Prevalence of Diabetes* * Self-reported history of diagnosed diabetes S2 vs. S1 : P=0.21 S3 vs. S2 : P=0.02 S3 vs. S1 : P=0.001 P=0.004

  6. Therapeutic Control of Diabetes* * Fasting glucose < 7 mmol/L in patients with history of diabetes S2 vs. S1 : P=0.82 S3 vs. S2 : P=0.03 S3 vs. S1 : P=0.08 P=0.04

  7. Prevalence of Smoking* * Self-reported smoking or CO in breath > 10 ppm S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.37 S3 vs. S1 : P=0.48 P=0.64

  8. Prevalence of Raised Blood Pressure (1)* * SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg S2 vs. S1 : P=0.83 S3 vs. S2 : P=0.51 S3 vs. S1 : P=0.65 P=0.79

  9. Medication Use: ACE Inhibitors & Angiotensin II RA S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

  10. Medication Use: Beta-Blockers S2 vs. S1 : P=0.001 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

  11. Medication Use: Antiplatelets S2 vs. S1 : P=0.29 S3 vs. S2 : P=0.0002 S3 vs. S1 : P<0.0001 P<0.0001

  12. Medication Use: Statins S2 vs. S1 : P<0.0001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001 P<0.0001

  13. Prevalence of Raised LDL Cholesterol* • LDL C ≥ 2.5 mmol/L for patients fasting for at least 6 hours P<0.0001 S2 vs. S1 : P=0.001 S3 vs. S2 : P<0.0001 S3 vs. S1 : P<0.0001

  14. Conclusioni dall’ EUROASPIRE surveys I risultati relativi ai trends temporali di variazione dello stile di vita sono decisamente sconfortanti: dimostrano come sia difficile per un adulto cambiare abitudini di vita ma rispecchiano anche la limitatissima attenzione riservata dai medici alla prevenzione non farmacologica (Guy De Baker, coordinatore nazionale per il Belgio di Euroaspire) I pazienti hanno bisogno di un supporto professionale per modificare il loro stile di vita e per correggere i loro fattori di rischio in maniera più efficace. Limitarsi a mettere loro in mano una ricetta non basta (David Wood, principal investigator di Euroaspire)

  15. Conclusions • ‘A handful of pills is not enough’ Professor David A Wood on behalf of the EUROASPIRE Investigators

  16. (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman) Obesity Trends* Among U.S. Adults: BRFSS, 1988 Mokdad A.H., CDC

  17. (*BMI > 30, or ~ 30 lbs overweight for 5’4” oman) (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman) Obesity Trends* Among U.S. Adults: BRFSS, 1994 Mokdad A.H., CDC

  18. (*BMI > 30, or ~ 30 lbs overweight for 5’4” woman) Obesity Trends* Among U.S. Adults: BRFSS, 2000 Mokdad A.H., CDC

  19. Obesity Management in an Outpatient Office Practice PatientBMI 27 40 31 20 37 33 21 29

  20. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1990 < 4% 4-6% 6-8% Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  21. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1995 < 4% 4-6% 6-8% Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  22. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 2001 < 4% 4-6% 6-8% 8-10% > 10% Source: Mokdad et al., J Am Med Assoc 2001;286:10.

  23. NHANES III Prevalence of Hypertension* According to BMI *Defined as mean systolic blood pressure 140 mm Hg, mean diastolic 90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000;8:605-619.

  24. The CRUSADE registry JACC 2008 52:979-985

  25. Cumulative Incidence of Heart Failure According to Category of Body-Mass Index at the Base-Line Examination Kenchaiah, S. et al. N Engl J Med 2002;347:305-313

  26. La pratica delle attività fisico-sportive oggi L’area totale dei cittadini attivi stimata dall’Istat-circa 36 milioni nel 1999,si è ridotta nel 2003 a circa 32 milioni e mezzo, mentre l’area della sedentarietà è salita da 19,5 a 23 milioni (sugli abitanti da 3 anni in su). AMS

  27. Weight Reduction Energy Intake < Energy Expenditure

  28. Dietary Therapy Low-calorie diets (LCD) are recommended for weight loss in overweight and obese persons. Evidence Category A. Reducing fat as part of an LCD is a practical way to reduce calories. Evidence Category A.

  29. Dietary Therapy Low-calorie diets can reduce total body weight by an average of 8 percent and help reduce abdominal fat content over a period of 6 months. Evidence Category A.

  30. MetabolicInfluence Reduction of obesity Enhancedglucosetolerance Improvedlipidprofile LifestyleInfluence Decreadedlikelihood of smoking Possiblereduction of stress Short termreduction of appetite Possible Biological Mechanisms for Exercise-Induced Reductions in All-Causes and Cardiac Mortality

  31. Increasedphysicalactivitywith or withoutweigthreduction,improvesinsulinaction and reducesinsulinresistance in obese persons. (evidence A) Endurance exercise training whencombinedwithweigth loss of > 4-5 Kg improves the lipid-lipoproteinprofilbyraising HDL cholesterol and loweringtrigliceridisamongoverweigth and obese men and women. (evidence A) Dynamicaorobicphysicalactivitywith or withoutweigth loss,reducesbloodpressureamongoverweigth and obese with the greatesteffectseenamongpersonswithhypertension. (evidence A) Exercise as Therapy: Evidence Based Sport Medicine D.MacAuley,T.B Best 2002

  32. Reductionofrestingbloodpressure 4 Systolic BP Diastolic BP 2 0 -2 Net BP effect in intervention compared to control with 95% confidence interval (mmHg) -4 -6 -8 -10 -12 -14 -16 All 48 comparisons 14 comparisons In hypertensives 7 comparisons In Border Line hypertensives 27 comparisons In normotensives J.Appl.Phys 1997

  33. Relationship Between Physical Activity and Maintenance of Weight Loss P<0.001 Subjects Exercising (%) Not Maintained Maintained Weight Loss Pattern Kayman et al. Am J Clin Nutr 1990;52:800.

  34. Effect of Decreasing Sedentary Activities vs Increasing Physical Activities on Body Weight in Children 6-12 Years Old Increased Physical Activity Change in Percent Overweight Decreased Sedentary Activity 0 4 8 12 Time (months) Epstein et al. Health Psychol 1995;14:109.

  35. Favorire la pratica dello SPORT Incrementare l’ Esercizio fisico quotidiano Promuovere l’ attività fisica Ridurre il sedentarismo Piramide dell’ attività fisica

  36. ACSM/AHA 2007Recommendations Physical Activity and Public Health Circulation 2007;116-1081-1093 William L H, Russel R.P. ..... Moderate-Intensity Aerobic activity for at least 30 min day for 5 days a week ......Vigorous-intensity activity for 20 min three days each week

  37. INTERHEART Risk of AMI associated with Risk Factors in the Overall Population

  38. 2.9 2.4 1.9 3.3 13.0 42.3 68.5 182.9 333.7 512 256 128 64 OR (99% CI) 32 16 8 4 2 1 INTERHEARTRisk of AMI with Multiple Risk Factors Smk DM HTN APoB/A 1+2+3 all4 +O +PS All RFs

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